Solitary spinal epidural cavernous angioma: report of nine surgically treated cases and review of the literature

Abstract

SEC is hard to be differentiated from other epidural spinal lesions before intervention but should be considered in the list of differential diagnosis regarding its favorable outcome.

Intradural spinal, extramedullary, T4-T5 cavernous hemangioma - case report

“…Capillary hemangiomas are found in the skin and soft tissues in younger people, and rarely occur in the central nervous system; more frequent they are located around or attached to nerve roots of cauda equina and conus medullaris (25), extremely rarely intradurally (16) 16,25) Clinical symptomatology at presentation is variable, depending on the size and topography, with the more frequent symptoms beeing: acute spinal pain, radiculopathy and/or myelopathy, progressive gait disturbance, slowly progressive paraparesis, or even asymptomatic -very rare, as in our case (5,18,(26)(27)(28). Cavernous hemangiomas may present in four major clinical patterns: acute episodes of step wise deterioration, slow progression, acute onset with rapid deterioration, and acute onset with gradual decline (10,12,14,15,18). Acute clinical deterioration is present in cavernous hemangiomas associated with subarachnoid hemorrhage induced by intralesional hemorrhage, lesion growth, thrombotic venous occlusion; bleedind can occur due to the thin-walled vessels, stasis of blood flow in the lesion, estrogen mediated neoangiogenesis in the lesion or drainer compression by a gravid uterus (22)(23) The MRI signal intensity and character of the spinal epidural cavernous hemangioma reflects its histopathology:…”

“…-both T1-and T2-weighted images lack of a low-signal hemosiderin ring relate to the more rapid removal of blood degradation products outside the blood-brain barrier (31)(32) -low or intermediate signal intensity on T1-weighted, and high-signal intensity on proton density and T2-weighted images, with strong homogeneous enhancement after contrast medium injection (14) -marked hyperintense T2 -weighted signal reflects the high water content and the intense flow enhancement into the numerous vascular channels of the lesion -sinusoidal vascular structure (36).…”

“…Either capillary or cavernous, intradural, spinal, extramedullary hemangiomas can be solitary or multiple; they are well-defined lesions composed of blood-filled endothelial spaces lined by thickened, hyalinised walls without elastic fibers or smooth muscle; they are also very rare (8)(9)(10)(11)(12)(13)(14)(15)(16). We report an intra dural spinal extramedullary, T4-T5 cavernoma in a 56-years-old woman, who underwent microsurgical resection.…”

Clinical characteristics and surgical outcomes of solitary spinal epidural cavernous angiomas

“…Contrast-enhanced T1-WI shows homogeneous enhancement because of much sinusoid structure in the tumor (4); nevertheless, sometimes heterogeneous signal can also be noticed due to intralesional hemorrhage or thrombus (10,14). The most striking difference in the MRI characteristics between epidural and intramedullary CAs is the lack of a ring of hypointensity from hemosiderin deposit (9,16). This may be result of more rapid removal of blood products outside the blood-brain barrier (2).…”

“…Solitary epidural CAs not originating from the vertebral bone are relatively rare. With the aid of magnetic resonance imaging (MRI), solitary epidural CAs are being discovered in increasing numbers; nevertheless, most previous studies are case reports with an associated literature review and large series studies are very limited in the literature (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Because of the risk of spontaneous and intraoperative bleeding, solitary epidural CAs need to get neurosurgeons more attention.…”